The Pediatric Resident Mental Health Rotation: Implementing the ACGME Requirement

The need for improved mental and behavioral health training for pediatric residents has been recognized for over 40 years. During this time, the prevalence of child behavioral health issues has steadily increased, culminating in the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declaring a national emergency in children's mental health in 2021. In response, the Accreditation Council for Graduate Medical Education (ACGME) implemented new mental health training requirements for pediatric residents beginning in July 2025. A core group of Brown University Health faculty designed and launched a structured rotation with milestone-informed goals and objectives, clinical experiences, and didactic components. These efforts align with Brown's longstanding commitment to address child and family mental health within a pediatric context. Pre- and post-surveys, qualitative data, and participant feedback were collected. Over 40 residents have participated in the rotation, appreciating the opportunity to tailor experiences to their individualized learning goals. A survey evaluating knowledge and comfort in assessing, diagnosing and treating common mental health conditions was administered before and after the didactic curriculum. Paired t-tests were conducted to evaluate changes in self-efficacy before and after the curriculum. Residents across all years of training reported improved knowledge and comfort in assessing, diagnosing and treating depression, suicide, and attention-deficit/hyperactivity disorder (ADHD) after delivery of the didactic mental health curriculum (all p ≤ 0.05, n = 15), and many of these improvements were sustained at six months. Areas for improvement include increasing first-year exposure to mental health training, creating longitudinal experiences, including direct clinical involvement within the Med-Psych service line, and expanding supported faculty time and resources for development.